• Journal of Oral Medicine and Pain
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• v.40 no.2
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• pp.72-78
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• 2015

Purpose: The purpose of this research was twofold: to compare the short-term efficacy of once-off education versus repetitive education (RE) of patients suffering from temporomandibular disorders (TMDs) and to determine whether there was any correlation amongst patient demographics, recommendation adherence degree and pain levels. Methods: A total of 848 patients with TMDs were enrolled. The control group consisted of patients who received a standard conservative treatment (STD) over at least 6 visits with education provided only during the first visit. The experimental group consisted of patients who received STD but had also been given RE (STD+RE). The RE was delivered through a standardized self-assessment questionnaire (SAQ) that was completed by the patient during each visit. Pain, which included maximum comfortable opening (MCO) of the mouth and limitation of mouth opening (LOM), was compared between the two groups. Behavior pattern and reported pain level changes in the group who used the SAQ were also analyzed. Results: The LOM was significantly improved in all of the experimental group patients (especially in females under 30 years of age, p<0.05). The MCO was significantly higher in females (p=0.029). All of the patients displayed improvements in their habits following RE, which resulted in a strong correlation with pain reduction. Adhering to the recommendations regarding questions 14 and 15 of the SAQ appeared to have the greatest effect on pain reduction. Conclusions: These results clearly demonstrate that RE is more effective than once-off education for TMD patients who are female or under 30 years of age.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.542-547
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• 2014

Background Abdominal wall free flaps are used most frequently in autologous breast reconstruction, and these flaps require intact and robust deep inferior epigastric perforator (DIEP) vessels. Pfannenstiel incisions are often present during preoperative visits for breast reconstruction and could potentially signal compromised blood supply to the lower abdominal wall. In this study, we compared the number of DIEP vessels between patients with and without Pfannenstiel incisions undergoing autologous breast reconstruction. Methods A retrospective review of medical records was performed for patients with (study) and without (control) Pfannelstiel incisions (n=34 for each group) between June 2010 and July 2013. In addition to patient demographics, number of caesarian sections, and outcomes of free flap reconstruction, abdominal wall vasculature was compared using the preoperative computed tomography angiographic data between the groups. For each patient, vessels measuring greater than 1 mm were counted and divided into four sections of the lower abdominal wall. Results The mean number of perforator vessels was 10.6 in the study group and 11.4 in the control group, which was not statistically different (P=0.575). Pfannenstiel incisions with history of repeat caesarian sections were not associated with decreased number of perforator vessels. Conclusions Pfannenstiel scars are associated with neither a change in the number of DIEP vessels nor decreased viability of a free transverse rectus abdominis myocutaneous and DIEP flap. Lower abdominal free flaps based on DIEP vessels appear safe even in patients who have had multiple caesarian sections through Pfannenstiel incisions.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.241-244
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• 2011

Introduction: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. Objectives: This study examined whether the sedative consumption of the patient with a high anxiety level increased. Patients and Methods: Patients with state anxiety scores of ${\geq}$51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. Results: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. Conclusion: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.146-152
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• 2020

Background Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. Methods We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. Results Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were "miscellaneous." In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. Conclusions CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

• Journal of Trauma and Injury
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• v.21 no.2
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• pp.128-135
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• 2008

Purpose: As the care of surgical patients becomes increasingly complex and catheter-based techniques are more frequently applied, the pattern of iatrogenic vascular injuries may be increasing. Major vascular injuries can jeopardize a patient's life or limb survival. The purpose of this study was to examine the current etiology and prognosis for iatrogenic vascular injuries. Methods: We reviewed medical records of 29 cases of iatrogenic vascular injury that were treated Seoul National University Bundang Hospital between October 2003 and October 2008. We studied clinical variables including demographics, cause of injury, clinical presentations, management and prognosis. Results: The mean age was 60.8 years (range: 25-86), and the male to female ratio was 1.9 : 1. The causes of injuries were operation related complication in 18 cases (62.1%), endovascular intervention and diagnostic angiography in 11 cases (37.9%). The types of vascular injury were partial severance in 14 cases, pseudoaneurysm in 8, arteriovenous fistula (AVF) in 3, thrombosis in 2, complete severance in 2. Especially, device related complication including percutaneous closing device were occurred in 9 and the others came from inadvertent physician's procedure. Primary repair were done in 12 cases, end-to-end anastomosis in 5, interposition graft in 4, ligation in 2, patch angioplasty in 1, peudoaneurysm excision and arteriorrhaphy in 1, hematoma evacuation in 1, and endovascular repair in 3. There were 2 cases of mortality, one of them due to hemorrhagic shock and the other due to septic shock. Conclusion: Proper selection of treatment modalities should be important to have better outcome according to the type of injury as well as anatomical location. Each physician should be familiar to new device as well as patient's topographical feature. Immediate referral to vascular specialist is also essential to reduce morbidity.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.21-25
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• 2005

Background and Objectives: The popularity of complementary and alternative medicine(CAM) has grown at an astonishing rate in recent years. Because patients are interested in CAM and want to use it, physicians also should be concerned about CAM and know about the current situation of its usage. In this study, we tried to determine the prevalence of CAM use in the patients with head and neck cancer and correlate with demographics and tumor characteristics. Materials and Methods: A total of 87 patients with head and neck cancer previously treated with surgery at Seoul National University Hospital from March through June, 2004 were enrolled in this study. The patients were completed, questionnaire about the use of CAM and demographic information. Tumor characteristics were obtained from the patient's medical records. Results: Of the 87 patients, 33 patients(37.9%) use at least one CAM. There was no statistically significant correlation between patient's data and prevalence of CAM use. Of those patients using CAM, 16(48.5%) of 33 were using 2 or more therapies. The majority of agents used by patients in this study are mushrooms such as Phellinus and Reishi, followed by dietary therapy. A majority(60.6%) of patients were introduced to alternative medicine by friends or family members. Conclusion: Considerable cancer patients use CAM. Head and neck oncologists should inform themselves about CAM to counsel and educate the patients. Further scientific investigations on promising CAM agents may help advance cancer treatment.

• Health Policy and Management
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• v.31 no.4
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• pp.451-461
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• 2021

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion: "Reducing the readmission rate" is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.177-182
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• 2021

Purpose: Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries. Methods: We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients' demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records. Results: A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3). Conclusions: For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient's hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

• Journal of Clinical Nutrition
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• v.10 no.2
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• pp.38-44
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• 2018

Purpose: Parenteral nutrition (PN) is known to provide therapeutic beneficial improvements in malnourished patients for whom enteral nutrition is not feasible. The objective of this study was to investigate the current clinical characteristics and utilization of PN in Korea. Methods: We analyzed the Health Insurance Review Agency National Inpatients Sample database from 2014 to 2016, which included 13% of all hospitalized patients in Korea. Adult patients aged 20 years or older and receiving premixed multi-chamber bag containing PN were included for this study. Patient characteristics, admission type, primary diagnosis, and hospital demographics were evaluated. SAS version 9.4 was used for data analysis. Results: From 2014 to 2016, 149,504 patients received premixed PN, with 226,281 PN prescriptions being written. The mean patient age was 65.0 years, and 81,876 patients (54.8%) were male. Premixed 3-chamber bag and 2-chamber bag PN solutions were utilized in 131,808 (88.2%) and 32,033 (21.4%) patients, respectively. The number of patients hospitalized through the emergency department were 70,693 (47.3%), whereas 43,125 patients (28.8%) were administered PN in intensive care units. In the adult PN patients, the highest primary diagnosis was malignant neoplasm of the stomach (8,911, 6.0%), followed by organism unspecified pneumonia (7,008, 4.7%), and gastroenteritis and colitis of unspecified origin (6,381, 4.3%). Overall, 34% of adult PN patients were diagnosed with malignancies, the most common being neoplasm of the stomach (17.7%), neoplasm of bronchus/lung (11.2%), neoplasm of colon (11.1%), and neoplasm of liver/intrahepatic bile ducts (10.0%). PN solutions were most frequently administered in the metropolitan area (55.0%) and in hospitals with more than 1,000 beds (23.6%). Conclusion: PN was commonly administered in older patients, with primary diagnosis of malignancy in a significant number of cases. This study is the first large-scale description of PN-prescribing patterns in real-world clinical practice in South Korea.

• Korean Journal of Head & Neck Oncology
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• v.34 no.2
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• pp.17-21
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• 2018

Background/Objectives: Cancers of the abdominal or pelvic organ rarely metastasize to the cervical lymph nodes. Although it indicates distant metastasis, perceivable prolongation of survival or cure may be possible in selected cases. We sought to identify patients with cervical metastasis from cancers below the diaphragm and identify patients who may benefit from aggressive treatment. Materials & Methods: From 2009 to 2017, patients with pathologically confirmed metastatic cervical lymph nodes originating from below the diaphragm were included for analysis. Patient demographics, cancer characteristics, treatment course, and clinical outcomes were analyzed. Results: 208 patients were identified. Left supraclavicular node (Virchow's node) was the most frequently involved. Irrespective of treatment, survival for uterine cervical and ovarian cancers was significantly longer than that of other primaries. Patients with isolated cervical metastasis (oligometastasis) had significantly longer median survival compared to patients with concomitant bone, lung, brain, and mediastinal metastases. Conclusion: Although cervical metastasis from cancers of the abdominal and pelvic organ represent distant metastasis, patients with uterine cervix and ovary primary and oligometastatic lesions may benefit from aggressive treatment. Prudent patient selection and further investigation is warranted.